A Theory of Addiction

My new theory about addictions, at least about the explosive increase in serious opioid addictions in the last few years:

I am well aware of the culpability of Purdue Pharma promoting Oxycodone, Oxycontin as “non-addictive”, coupled with an “academic” push to have doctors pay more attention to chronic pain, and then some sloppy prescription practices after acute injuries. And I am well aware that some addictions begin as self-medicating, usually self-medicating a mood or anxiety disorder.

I understand how hooked they are. How, once addicted, consciousness is reduced to getting that fix. Empathy is lost along with any ability to think beyond the fix and the avoidance of withdrawal. By that point there are brain changes and it is a disease.

And pockets of addiction can be found alongside unemployment, poverty and despair.

But this is 2018. Not 1932. There really is no shortage of easily acquired food, and despite the cries for more affordable housing for families, there really is no shortage of basic shelter for single men.

So why now are so many men sleeping on benches and on the hustle for drugs around the Sally Ann in my neighbourhood? And why is the otherwise fit looking man with his German Shepard dog willing to stand for hours in a cold drizzle at a busy intersection collecting coins from every tenth car that stops? And why on earth does anyone ever inject a substance into his vein that has a ?10, ?20 percent chance of killing him?

I have also had many clinical experiences of addicts, vague, unhappy, scattered in thought, pathetic in actions, but laser focused and energetic when it comes down to the moment of trying to persuade me to write a prescription. Tenacious, persistent, with far more stamina than I.

And here are two more seemingly unrelated bits of information: When we go on holiday our sense of well being peaks on day 8. It is downhill after that. Time to go back to work, we say, by day 12. And some zoos have learned that making the carnivorous animals hunt for their food, rather than just giving it to them, makes them happier and healthier. And the retired couple, free now of children, mortgage and job, free to roam in an RV. What do they always do? They get a dog, or two dogs to fuss over, look after.

We humans were not made for leisure. Our DNA tells us we need to hustle. We need to hunt for food, check the barricades, repair the roof, fashion the spear, dig the trenches, work for ten hours in the mine, or kitchen. We are programmed to be busy. And our busy-ness rewards us with food, safety, or some small achievement. (I am quite amazed how delighted I am when I manage to complete a New York Times Crossword puzzle and then cast it aside to look for a new one.)

Challenge, occupation, risk, reward, repeat. (note that this is the same sequence video games provide)

Our focus has been on the reward, the drug, swallowed, snorted or injected. We can make that safer with safe injection sites. We can eliminate the need for the hustle if we provide the drug. But what of the challenge, the occupation, the risk and the repeat? What of the need for the hustle?

My new theory is that these last few decades have removed the natural life challenges and occupations for more and more men, and that drug addiction provides just that. That is, it provides not just the reward (the drug) but also the challenge and occupation, the risk and repeat.

As do video games for the young man in his parents’ basement.

We can “treat” addiction, try to eliminate drugs, or provide the drugs legally, but how do we replace challenge, occupation, risk, reward, repeat as the robots take over all the work?

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7 thoughts on “A Theory of Addiction”

Meaningful goals, meaningful work, meaningful relationships. Yes, these are the keys to involved and satisfying living. Without these there can be no self esteem or will to live. Yet, we see loving parents become addicted; we see hard workers become addicted; we see the once determined student become obsessed with finding the next hit. Psychiatry fails to heal the addict. A redirection of focus is a good beginning. But we have far to go before we sleep.

Another excellent blog. Probably one of the most succinct explanations of how drug usage can go from recreational pleasure seeking to disease.
And I agree with our genetic makeup for challenge seeking. My experience is good addiction treatment works when they turn challenges of drug/alcohol seeking into challenges of sobriety seeking. So why can’t we make sure maintenance programs reinforce challenges of work, housing, etc,?

I can’t add to your worthy theory of addiction, but I wish to report that on my 78 yearly morning stroll I noticed some things this morning. I live in the down town in the ‘University District’ > walk and spy on my student neighbours. Before the clock strikes midnight some will be carted off in the paddy wagon if the past is anything to go by. I even like some of the students. But i do draw the line often.

The pot legislation was hurled in on Wednesday and we are about to start the usual feast of unwanted experiences of Queen’s HOMECOMING That is us “the dwellers” in these here parts. WE THE PEOPLE must put up with a lot of tosh, puke , garbage and bladder works Despite new rules it is unlikely to be different from other years. A few years ago , I suggested to the Principal that since since we can’t bring back hanging,what about a wall? His reply in jest was yes and we will pay for it.

We have a high wall in our back garden and some students have hurled their bottles over it not yet hitting the witch who resides therein.

My Friday morning stroll was well wafted by pot in the air . I think that is what it was, for it was all over the place and some students were puffing timidly (clearly not sure of the consequences or effects on their “cream of the crop” intellects) POT was vaguely evident everywhere . One person a bit older than the average student crossed in front of me and by the Catholic Cathedral, but left his perfume behind. These out in the open puffers looked a bit shifty to me. However we shall see. Could I be affected by second hand smoke .Perhaps the smokers were concerned for me.

Like lemmings they rush off another cliff and cause much trouble in their wake. The police budget for overtime is announced and we await the not so merry making debacle.to follow. But they are young, underage immature so must be forgiven! But they have joined the tribe of believers that Queen’s is a very superior place. Cheers! We live in interesting times. And the snowflakes keep coming.

You’ve ignored one major thing – early life trauma. Dr. Gabor Maté worked with hard core addicts on Vancouver’s Downtown Eastside for 20 years. Every one of his patients had been traumatized in childhood, especially sexual trauma. So the best way to deal with that pain is to use. Read his book, In the Realm of the Hungry Ghosts. Better yet, talk to him or go to one of his lectures. Several of them are online.

I have two problems with the reductionist view of ACE’s (adverse childhood events) being a specific and direct cause of all addictions. In saying this I do not mean to ignore the various terrible things some people experience in childhood, nor the life-long consequences of these experiences.

But:

1. If there is one characteristic common to all addicts, at least all I have seen in three provinces and two countries, it is that they lie. Whatever the origins and necessity of this pattern it becomes as common and easy as breathing for an addict. Thus, anything said by an addict must be taken with a few grains of salt. That includes retrospective self-reporting of childhood experiences. “You’re the best, Doctor D”, the addict says to my face while lying about what he has done, where he has been, and what he has swallowed or injected.

2. Psychoanalysts, doctors, counselors, therapists of all stripes have an uncanny ability to unearth in their patients’ stories exactly the causes and patterns that fit their pet theories.

3. A second common feature of addiction is the need for the addict to justify his or her behaviour, to ascribe cause and responsibility to something or someone else. (I am not singling out the addict here, for this a general human trait)

4. If I am to believe that the rapid rise of serious addiction over the past 20 or 30 years is a specific consequence of ACE’s then I have to assume there has also been a rapid rise in the percentage of children who experience ACE’ (in Canada or the USA) .
Which is clearly not true.

Yes to all your points i agree and especially with 2. Psychoanalysts, doctors, counselors, therapists of all stripes have an uncanny ability to unearth in their patients’ stories exactly the causes and patterns that fit their pet theories. Gupta Mate may be assumed to have this problem. I have listened to his excessive marketing of his beliefs.